Federal Investigation of Redding Physicians Examined
The Federal Bureau of Investigation's case against two former Redding physicians suspected of performing hundreds of unnecessary heart procedures to defraud Medicare "appears to have stalled," the Sacramento Bee reports. The U.S. attorney's office has not filed fraud charges, despite "repeated rumors since 2003 of impending criminal indictments against the doctors," according to the Bee (Griffith, Sacramento Bee, 6/26).
Attorneys in April 2004 filed the first of several anticipated lawsuits on behalf of hundreds of patients alleging misconduct at Redding Medical Center.
Attorney Robert Simpson filed a 300-page lawsuit on behalf of 82 people alleging fraud, conspiracy, battery, wrongful death, negligence and elder abuse. The complaint -- which names as defendants cardiologist Dr. Chae Hyun Moon, heart surgeon Dr. Fidel Realyvasquez, Redding Medical Center and Tenet Healthcare, which owned Redding at the time of the procedures -- results from a federal investigation of the practices of some Redding doctors (California Healthline, 4/29/03).
Redding has operated as Shasta Regional Medical Center since Tenet in July 2004 sold the facility to North Carolina-based Hospital Partners of America (California Healthline, 7/19/04).
In October of 2003, FBI, the U.S. Attorney's Office for the Eastern District of California and the HHS Office of Inspector General began investigating Moon and Realyvasquez for possibly performing unneeded surgeries and potentially defrauding Medicare. According to an FBI affidavit, government officials suspect that the physicians participated in a "scheme to cause patients to undergo unnecessary invasive coronary procedures," including artery bypass and heart valve replacement surgeries. No charges have been filed as a result of that investigation (California Healthline, 4/29/03).
A spokesperson for the U.S. Attorney's Office in Sacramento did not disclose details regarding the delay. However, several observers suggested an investigating federal grand jury might be "hampered by the complexity of the medical procedures in question and the range of opinion about what constitutes the accepted standard of care," the Bee reports.
To convict the doctors of fraud, federal prosecutors would have to prove that Moon and Realyvasquez "intended to deceive the government by knowingly performing unnecessary operations, then billing Medicaid or Medicare for their services," according to the Bee.
In January, Moon and three other Redding cardiologists settled with hundreds of patients in civil court for $24 million. Tenet paid $395 million to patients and $54 million to the federal government.
The Medical Board of California has not filed a formal accusation against Realyvasquez, who has not practiced medicine since February 2003. In addition, Moon faces a formal board accusation and in June 2003 agreed to a temporary license suspension, which remains in effect until any criminal proceedings are resolved.
Stephen Boreman, the deputy attorney general in charge of the medical board's case, said "The public is protected because (the doctors) are not practicing medicine," adding, "I don't view this as anything negative for the people of California" (Sacramento Bee, 6/26).